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Grid Computing represents the latest and most exciting technology to evolve from the familiar realm of parallel, peerto-peer and client-server models that can address the problem of fault-tolerant storage for backup and recovery of clinical images. We have researched and developed a novel Data Grid testbed involving several federated PAC systems based on grid architecture. By integrating a grid computing architecture to the DICOM environment, a failed PACS archive can recover its image data from others in the federation in a timely and seamless fashion. The design reflects the five-layer architecture of grid computing: Fabric, Resource, Connectivity, Collective, and Application Layers. The testbed Data Grid architecture representing three federated PAC systems, the Fault-Tolerant PACS archive server at the Image Processing and Informatics Laboratory, Marina del Rey, the clinical PACS at Saint John's Health Center, Santa Monica, and the clinical PACS at the Healthcare Consultation Center II, USC Health Science Campus, will be presented. The successful demonstration of the Data Grid in the testbed will provide an understanding of the Data Grid concept in clinical image data backup as well as establishment of benchmarks for performance from future grid technology improvements and serve as a road map for expanded research into large enterprise and federation level data grids to guarantee 99.999 % up time.

Purpose This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on Image-Assisted Minimally Invasive Spinal Surgery as a clinical application. Methods Three clinical Phases of Minimally Invasive Spinal Surgery workflow in Pre-Op, Intra-Op, and Post Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a Minimally Invasive Spinal Surgery clinical site with user training and support for daily use. Summary A step-by step approach was introduced to develop a multi-media ePR system for Imaging-Assisted Minimally Invasive Spinal Surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed.